Elected officials question Memorial Medical Center's compliance

By Diana Alba Soular / dalba@lcsun-news.com / @AlbaSoular on Twitter

Posted:
05/04/2014 01:55:23 PM MDT

LAS CRUCES >> Uncertainty about the state of psychiatric services at Memorial Medical Center sparked a rare, joint closed-door meeting of the Las Cruces City Council and the Doña Ana County Commission in recent days.

The governments jointly lease the hospital's campus and buildings to a private company, LifePoint Hospitals. They are weighing possible legal action against the health-care provider over one of the contract terms, which calls for the facility to offer mental health care.

An incident involving one mental health patient's experience with the hospital around the start of April created worry among mental health care advocates, who've long been concerned about gaps in the broader psychiatric care system locally. That, as well as reports about mental health care-related contract negotiations at the hospital and possible changes tied to the facility's in-patient psychiatric ward, called Five West, fueled more concern in recent weeks.

At least some mental health advocates feel the issues haven't been fully addressed publicly by the hospital. Similar sentiment brewed among some elected officials, spurring the closed session.

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Amid rumors, Memorial Medical Center has denied closing its 12-bed psychiatric unit. A spokeswoman has said the hospital is still taking patients in need of mental health care.

'Hospital of choice'

Memorial Medical Center is one of two main places that Doña Ana County residents experiencing crisis mental health episodes are taken after being placed into what's known as protective custody by law enforcement officers or a judge. It's not the same as a criminal arrest, authorities said. But it is involuntary.

A New Mexico state law allows for residents in crisis to be taken into protective custody for up to 24 hours by police for the purposes of a psychiatric evaluation, experts have said. The time limit is in recognition that a person's civil rights are being infringed upon. Via a separate route, a judge also can order that someone be taken into protective custody.

The Las Cruces Police Department takes protective custody residents to emergency rooms at Memorial Medical Center and MountainView Regional Medical Center because those are the only two locations that meet the police department's standard of being "secure," in order to maintain a proper legal chain of custody, said LCPD officer Robert McCord. Not only the physical environment factors into whether a place is "secure." Also, the policies and practices of a facility contribute, McCord said.

The hospital emergency rooms differ, for instance, from Mesilla Valley Hospital in Las Cruces and Peak Behavioral Health Center in Santa Teresa, advocates said. Those facilities offer in-patient psychiatric care beds. But because they're privately run and not in the ER business, there's no obligation for them to accept patients who often have no or little ability to pay.

The mental health hospitals also can allow patients to voluntarily walk away — which contradicts involuntary protective custody, said McCord, who oversees the department's Crisis Intervention Team, which frequently deals with people in protective custody.

"They can say, 'No, we're not going to do the evaluation. There's no mandate that says we have to.' So they don't,'" he said. "We can't rely on that. We need to be able to take them to a consistent facility that can do a proper evaluation."

Those evaluations lead to a person either being released from MMC or MountainView — if psychiatric staff determines the person is OK — or to the person being admitted involuntarily for in-patient behavioral health care for up to several days. If it's the latter, a process can be launched within five days to seek an even longer-term commitment, which if granted by a judge, can result in the person being taken to the state's psychiatric hospital in Las Vegas.

In 2009, city officials settled a class action lawsuit brought by the nonprofit American Civil Liberties Union of New Mexico and Protection and Advocacy System — now Disability Rights New Mexico. Part of it alleged city authorities were improperly using the county jail as de facto holding facility for mentally ill residents who hadn't committed a serious crime. Advocates said the lawsuit curbed the practice. But it also left the hospitals as the go-to places to take protective custody residents.

There's a difference between the two hospitals with ERs, though Las Cruces police say they take protective custody patients to both. MountainView Regional Medical Center contracts out to provide psychiatric care services but doesn't have a psychiatric ward.

"By virtue of Memorial having its own emergency room and having its own locked, secure psychiatric ward, that is the hospital of choice to take someone," said Ron Gurley, a longtime Las Cruces mental health advocate, referring to protective custody situations.

Gurley said the combination gives mental-health patients access to psychiatric care, but if another type of physical problem crops up, "they can take them to emergency care."

"And that's wonderful," he said.

Questions sparked

The incident helping to spark the recent uproar happened at the start of April when Las Cruces police officers, per a court order, delivered a resident who was in protective custody to Memorial Medical Center.

The man was initially turned away at the emergency room, said Gurley, who is his treatment guardian — someone granted certain decision-making authority for mental health care in a person's life. The police officers dropped off the patient at the hospital anyhow and left, having fulfilled the judge's instructions.

"Then I started looking for him because I didn't know what happened to him," Gurley said. "They'd ambulanced him over to Mesilla Valley (Hospital), and I couldn't find out anything. Finally, I got through and found out where he was."

Gurley expressed his concerns to City Manager Robert Garza and Doña Ana County Manager Julia Brown, who both also sit on the MMC hospital board. Gurley was worried about a closure of the MMC psychiatric unit — something that had been attempted when LifePoint Hospitals (formerly Province Healthcare) was hashing out the terms of a 40-year lease agreement with Las Cruces and the county about a decade ago.

"They tried to close Five West in that lease," Gurley said. "And we organized a potential civil disturbance, and they put it back in the lease before it was signed."

At issue is that the salaries for qualified staffing, psychiatric medicines and the time commitment needed to treat patients are all expensive, Gurley said.

"A psych ward is not a money maker," he said. "It's a cost-loser, big-time."

"The rumors that MMC has closed its behavioral health unit are not true," said hospital spokeswoman Mandy Leatherwood, in an emailed statement. "We have not had any closure of the unit."

But Leatherwood also said some mental health patients who arrive at the hospital's emergency room "may need to be transferred to receive in-patient care."

Some members of the public safety community had been told the hospital had some problems in negotiating a contract with a psychiatric provider. Advocates said that may have related to a behavioral health physician who'd been contracted to carry out initial assessments of mental-health patients who arrive the hospital's emergency room. It was after that step, at least in the past, that a person would be taken to the hospital's psychiatric ward if he or she was deemed to be in a crisis state.

Pamela Field, state board member for the nonprofit National Alliance for the Mentally Ill, said she isn't "clear on what's happening" at MMC. Mixed messages are coming from the hospital, she said.

"I'm very disappointed in the way Memorial has handled this in terms of communication," she said. "It seems to be causing a lot of anxiety and panic."

'Business as usual'

McCord said he was aware of the situation involving the protective custody resident in early April. He said he spoke with a hospital official about it.

"I don't know if that was a breakdown in communication with ER personnel or what," he said. "I talked with the administrator, and he assured me it was business as usual as far as the police is concerned."

From LCPD's perspective, there haven't been problems since, McCord said.

"That's what I've experienced. There's been no change as far as us taking our protective custody issues," he said. "Anybody that has a breakdown in this community who's taken into protective custody by the police will get the help they need."

City Manager Garza said he's spoken to hospital CEO John Harris, who has "assured me that nobody is being turned away."

Lease questioned

Still, questions have arisen about the hospital's behavioral health care obligations under the city and county's lease with it, such as whether it's required to have a psychiatric unit or whether it can outsource that type of service to another provider.

City and county officials are asking whether the hospital is complying with the terms of the 40-year lease — the point of the joint closed session last Wednesday, officials said.

The city and county sought documentation from the hospital to "explain how MMC is compliant with that portion of our lease," Garza said.

"If they're not satisfied there's compliance, the city manager and the county manager will get feedback from the boards and go from there," he said prior to Wednesday's joint closed meeting.

No immediate action was taken by the City Council and County Commission after the meeting.

Garza said Thursday that a review happened during the session, but he couldn't "say more about the details because there's still a potential for conflict regarding the contract."

If elected officials decide there are shortcomings in what the hospital is doing, they could pursue legal action as a remedy.

County Commissioner Wayne Hancock said he believes the lease terms call for the hospital to provide psychiatric services, including the psychiatric ward. But the wording is "a little squirrely" in some areas.

"There are some loopholes in the contract, but those are the kinds of things we leave to lawyers. It's a shame policymakers at the time didn't deal with those loopholes," he said, referring to the drafting of the lease.

County Commissioner Ben Rawson said a big challenge he sees is that "there's a lot of miscommunication out there" about the situation.

"I think it will get cleared up," he said.

County commissioners are working to open a new facility, called the Crisis Triage Center, which — depending on how they decide to run it — may reduce the number of protective custody residents being taken to local emergency rooms. Instead, they'd go to the triage center.

But even after the new facility is up and running, the need for MMC's psychiatric ward will remain, Hancock said. That's because — beyond the initial psychiatric evaluation, which likely will happening in the Crisis Triage Center — in-patient beds will still be needed for patients who must be involuntarily kept for several days.